A painful and serious gut problem is increasingly afflicting younger Americans, and no one’s sure why. Recent research shows that cases of severe diverticulitis among people under the age of 50 have substantially risen over the past two decades.
Scientists at the University of California, Los Angeles, and others examined data from millions of Americans hospitalized by diverticulitis. They found that the proportion of severe, or complicated, diverticulitis cases in younger Americans noticeably increased between 2005 and 2020. The reasons for this surge are unclear, the researchers say.
“Additional research is needed to determine the cause of these trends and identify public health policies aimed at potentially preventing the increasing burden of diverticulitis among younger populations,” they wrote in their paper, published in the journal Diseases of the Colon & Rectum.
A problematic pouch
The outer wall of our large intestine can develop a pocket- or pouch-like structure alongside it, formally known as a diverticulum (diverticula for plural). These pouches are harmless on their own, and most people will never be bothered by them. But the pouches can become inflamed and/or infected: a condition we call diverticulitis.
Most cases of diverticulitis are uncomplicated, meaning the inflammation is localized. Though painful, this form can usually be managed with rest, a change in diet, and occasionally antibiotics. Complicated cases are caused by more widespread inflammation, which can then lead to severe, potentially life-threatening issues like gastrointestinal bleeding, abscesses, and even a ruptured colon. It’s these cases that often require hospitalization and sometimes radical interventions like the surgical removal of some or all of a person’s colon (a colectomy).
Cases of diverticulitis, both mild and severe, are much more common in people over 50. But this latest research suggests that things are changing, and not for the better.
A worrying trend with no clear answer
The researchers analyzed data from the Nationwide Inpatient Sample, the country’s largest publicly available database of hospital visits.
Between 2005 and 2020, they found, at least five million Americans were hospitalized for their diverticulitis. About 16% of these cases were early-onset, occurring in people under 50. Over time, the researchers found, more of these early-onset cases led to severe illness. During the study period, the percentage of severe diverticulitis among early-onset cases significantly increased, from 18.5% to 28.2%.
On the positive side, people with early-onset diverticulitis were less likely to die from their condition than older cases and had shorter hospital stays on average. The proportion of early-onset cases treated with colectomy also declined over time (from 35% to 20%), suggesting that doctors have gotten better at managing the condition with less intrusive measures. But younger people were also more likely to require surgery or other invasive treatments for their condition than older patients.
At this point, the researchers say, there’s no easy explanation for why these cases are becoming more common in younger Americans. It is possible that some of the same risk factors linked to increased early-onset cases of colorectal cancers, such as obesity, may also be driving an increase in diverticulitis. Other lifestyle factors, such as a diet high in fiber, are thought to lower people’s risk of diverticulitis, and most Americans simply aren’t getting enough fiber in general. Younger people also seem to be exercising less than earlier generations, and physical activity is another protective factor against diverticulitis.
Without more study, though, we can’t know for sure just how much these and other factors could be playing a role in early-onset diverticulitis.
“Little is known about why we’re seeing this increase in younger patients,” said lead author Shineui Kim, a researcher at UCLA Health, in a statement from the university. “We urgently need additional research to determine what’s driving these trends, whether it’s dietary factors, lifestyle changes, obesity rates or other environmental influences.”
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